Medicaid Expansion and the Spiritual Side of Health Care: An Interview with Matthew Ellis of Episcopal Health Ministries

Matthew Ellis is the CEO of Episcopal Health Ministries in Indianapolis, Indiana, which works to promote health ministries in Episcopal congregations throughout the country. Ellis has served on the Health Task Force of the National Council of Churches, the Older Adult Ministries of the Episcopal Church, and the Anglican Health Network. Ellis was the executive director of the National Episcopal AIDS Coalition and worked as a human services consultant at Healthy Families Indiana. In addition, Ellis is one of the faith leaders for the 2014 Faith and Reproductive Justice Leadership Institute at the Center for American Progress.

SS: Matthew, I want to start with a report I read on your website. Rev. Martin E. Marty, who is a well-known faith leader, said that if you want to support health and healing in a community, the major vehicle is the local congregation.

ME: One of the things he also said is that it can take a long time for the obvious to be spotted. We’ve all had that experience where we had a problem that we’ve been wrestling with and someone points out a solution that seems like it should have been obvious from the start. In some ways, utilizing congregations to promote community health is very much like that. It’s an obvious place to address health.

SS: What can local congregations do?

ME: They can play several roles—not just for members of that specific congregation but for the larger community as well. First of all, places of worship have a unique place in our society, discussing health and care of the body in a spiritual context. We need to be well ourselves in order to serve others. For myself, I often get migraine headaches, and when I have one, I am no good to anybody else! I can do things to mitigate that; I have preventative medicine, I can eat better and avoid the triggers that cause headaches—and that allows me to be more productive and serve others to the best of my ability.

We talk a lot about healing in our faith traditions and the importance of caring for each other. Congregations are still somewhat unique in bringing people together. Our society has become isolating in so many ways. For me, congregations are one of the places where we still interact with those who may be different from us. These characteristics, combined with churches’ actual physical space in the community, provide some particularly interesting opportunities to address health.

SS: What you are saying is that religion is connected to health, to the body and soul.

SS: So far, we have been talking about congregations and health in interpersonal ways. I’d like to bring in policy. With Episcopal Health Ministries, Episcopal churches across the country are working to get people enrolled in the Affordable Care Act’s health exchanges. Why did you get involved, and how are things going?

ME: Well, obviously, as Episcopal Health Ministries, we see community health as one of the things we try to have an impact on. It is a very important part of our work, and one part of that work is education. We’ve been particularly active in trying to provide our networks with accurate, clear information and encouraging them to share it. I think that there has been an awful lot of misinformation—sometimes deliberate, sometimes accidental—and that is one of the things that’s caused people to be confused about the health care law–whether it even is a law at this point.

We’ve tried to break it down and provide very simple, clear, and accurate information. And we have gotten a wonderful response. Some of our parishes and members have gone a lot further than education. For example, St. Matthews in Louisville, Kentucky, had the director of the Kentucky Health Benefit Exchange come in and do one of their morning information sessions on how Kentucky is implementing the Affordable Care Act. Grace Episcopal Church in Chattanooga, Tennessee, hosted a breakfast and forum.

The Episcopal Diocese of Los Angeles has developed a program where they go out and enroll people in the Affordable Care Act. And it’s not just church members they’re enrolling but also people in the community at large. They help them determine their eligibility and their options for insurance. Churches around the country have been holding training sessions that are educational and involve enrollment.

Churches are a wonderful place to do this. If you think about some of the people who are really vulnerable, churches are often one of the few places where we can catch them and know that they’re going to be there. Food pantries and community meals can help make sure that some of our most vulnerable populations are getting the information they need.

SS: That’s terrific. The Affordable Care Act is highly political. How do you navigate that?

ME: You know, I’ve been pleasantly surprised that we have not received a lot of criticism or a lot of questioning about this.

SS: That’s great. We should send you around the country to do this work!

ME: Well, you know, Sally, one of the things we do that I think is really key, is we don’t call it Obamacare. That is such an emotionally charged term for people—either for or against—that it just causes a real reaction.

We say the Affordable Care Act. And I’ve found that even people who disagree with it respect that approach and are more open to having a discussion. We don’t ask people to endorse the law or to think it’s the greatest thing ever. We simply say, “These are the facts, these are the start dates, these are the enrollment times, this is the website.” And then we ask people to help us implement the law. Vulnerable people need it, and you may not agree with it, but this is the way people are getting health care. We all have a vested interest in making sure that people are able to access it.

SS: I want to go back to something you said a few minutes ago. When you were talking about education, you said that a lot of people are confused and don’t know that the Affordable Care Act is the law of the land.

ME: It is true. The Kaiser Family Foundation, which has done fantastic work on the Affordable Care Act, has just come out with another survey. Forty-six percent of people who are uninsured are unaware that they have the opportunity to get subsidies to help them purchase coverage. And another 53 percent do not know that they cannot be denied coverage. To me, these are two of the things that have been the most heavily promoted, and so to realize that so many people don’t realize that these are possibilities just really blows my mind.

SS: I want to follow up on that: One piece of the Affordable Care Act is Medicaid expansion. That’s a really important piece of the law because it extends coverage to vulnerable populations. However, 25 states have not yet expanded Medicaid, so millions of Americans have no health insurance at all.

ME: Medicaid expansion is a very important piece of the Affordable Care Act. But it can be complex to discuss; it doesn’t boil down to simple sound bites—I just need to say that right off the bat.

SS: Okay, settle in, readers and listeners! Here comes expansion!

ME: Yeah, get your popcorn! So when the Affordable Care Act was passed, it was assumed that all states would implement Medicaid expansion. But the Supreme Court ruled it was optional, which provided an out for states that didn’t want to expand Medicaid. That has caused problems with implementation because a lot of people are falling through the cracks.

For instance, in my home state of Indiana, it is possible to make too much money to qualify for Medicaid but not make enough money to qualify for subsidies on the health exchange. There’s this strange middle ground where a lot of folks are getting caught. If a state is not going to implement Medicaid expansion, I think they have a real responsibility to figure out something that addresses those folks.

SS: They’re ineligible on both ends. They really have fallen through the cracks. Why do you think faith voices are important in this debate?

ME: Faith voices are powerful, and I’d like to highlight a success. In Ohio, they passed Medicaid expansion—with a Republican governor—and in large part it was the faith community that helped push that. There was a united call from various leaders—a call that two of the Episcopal bishops supported. Bishop Thomas E. Breidenthal and Bishop Mark Hollingsworth both wrote on behalf of Medicaid expansion. Greater Cleveland Congregations, which is an organization of many faith groups, came together and supported Medicaid expansion. It mobilized its membership to let its legislators know this was important and that they saw it as a moral issue. So that is one major success in which the faith community played a significant role.

SS: It also makes economic sense because states are going to save a lot of money by expanding Medicaid.

ME: That’s right. I may be a little off on the numbers, but I think the federal government pays 100 percent for the first three years, then 90 percent thereafter. Those states not expanding Medicaid are still paying for it. You don’t get a discount on the federal tax you pay; you are just subsidizing the other states that are expanding Medicaid.

SS: It will be interesting to see, with a state that decided not to expand Medicaid that is next door to a state that expanded Medicaid, if the health and well-being of its neighbors becomes apparent.

ME: Well, we are seeing that in Indiana and Kentucky right now. There have been several newspaper profiles of someone who lives across the river in Indiana and is in that hole where they don’t qualify for Medicaid expansion or the subsidies. If they lived just a half mile on the other side of the river, they would have a completely different situation.

SS: Stories like that have got to have an impact.

ME: I would think so. I would get an apartment on the other side.

SS: Matthew, I have one last question for you. It’s about the Faith and Reproductive Justice Leadership Institute, where you are a leader. You recently wrote a blog post that I really liked. It was soon after our convening in Washington, and you explained why it was important for you to participate in the institute. Can you share what you said in that post?

ME: Sure. I thought long and hard about joining the Leadership Institute. I discussed it at length with my board of directors because the issue most people think of when they hear reproductive justice is abortion. But we know that it’s a lot more than that. Certainly, that is one of the major issues, and I have several board members who are pro-life in pretty much all cases. I wanted to make sure that we were all going to be comfortable with participating in this if it seemed like the right thing to do.

So in discussing that with them, we came to a couple of different conclusions, and we worked through a couple of different questions. The first is: Is this work consistent with our mission? We all felt that it is. The second is: Does the Episcopal Church have clear statements on these issues? And the Episcopal Church does—particularly with abortion, it has what I find to be a wonderfully nuanced and respectful policy in which it does not endorse abortion for every circumstance but does respect the individual’s right in the decision-making process in every circumstance. It’s not necessarily encouraging, but it is insistent that nobody be restricted from access. That seems like an important thing for us to make sure that people know about.

Another question is: Is this work being addressed sufficiently by others in the church? We did not really see a whole lot of people who had been working at a high level, at least nationally, on this issue. So we felt like there was a place for us to have a voice.

And then: What is the relevance to our network and our members, and why is it important for us to do this? I think that faith communities for so long have let other people speak for them, even though they do not necessarily share their views. I think the Episcopal Church is in that boat.

So if you are somebody who is not overjoyed at the realization that you are pregnant, and you’re struggling with how to process that, and you want to involve your spiritual views in that decision-making process, it is important for you to know how you’re going to be received by your church—whether or not it’s going to be a respectful process through which they help and support you and participate in your decision making in a way that is respectful of you, or whether there’s going to be judgment and an attempt to dictate your decision.

So for us, it seems like we have not done a very good job of publicizing what the Episcopal Church’s position is. Especially for our faith community nurses who are doing health ministry, it seems that if you are unsure of how you are going to be received by the church, you’re probably not going to the rector or the priest, you are probably going to try to find some people who work in the health ministry and sound it out with them. That is another reason why I think it’s very important that all of our folks in our network, at all levels, understand the Episcopal Church’s position and are participating in these discussions.

There are all kinds of issues we want to have a voice in, including family planning, contraception, and the Medicaid expansion. We thought long and hard about it and decided that the Leadership Institute was definitely a place where we wanted to contribute our voice.

SS: It’s a valuable voice. As you’ve said, all these issues are connected. Having affordable care, having health insurance, having access to contraception means fewer unintended pregnancies—and, hopefully, fewer abortions. I love what you said about the importance of pastoral care and a woman being able to be open and honest with her faith community, to know that she will be treated with compassion and respect and not be stigmatized and judged.

ME: Absolutely. I think we would all hope that she would be able to discuss that issue with the members of her faith community.

SS: Thank you so much for the work that you’re doing, thank you for your voice, and we really look forward to working with you this year.

ME: Thanks for the opportunity. I really appreciate it.

This interview has been edited for length and clarity.

Sally Steenland is Director of the Faith and Progressive Policy Initiative at the Center for American Progress. You can learn more about this project here.